Should the ileocecal valve be reconstructed during resection?

[David]

I recently asked our panel of experts:

If a patient is facing removal of the IC valve, how viable is a surgical rebuilding of the valve? Are such procedures successful and should patients find a surgeon that performs such a procedure?

Dr. Walter A. Koltun, MD, FACS, FASCRS of the Penn State Hershey Inflammatory Bowel Disease Center took time out of his busy schedule to answer this question. A little about Dr. Koltun:

Dr. Koltun is the Director of the Hershey Penn State IBD Center, Chief of the Division of Colon and Rectal Surgery, and Professor of Surgery at the Penn State College of Medicine

In regards to the question, Dr. Koltun stated:

The IC valve or ileocolic valve is the structure that marks the transition from the small bowel (ileum) into the large bowel or colon. In most people it does not serve as a true valve. In other words, if one gets a barium enema X-ray in a normal healthy person, with dye going backwards from the anus, through the colon, it will commonly go back into the small bowel, through the IC valve reflecting this baseline ‘incompetence’. In a patient with Crohn’s disease, the inflammation and scarring almost uniformly destroys any valvular function it may have had. It is not accepted practice to try to reconstruct a valve when doing an operation that removes this area of the bowel (called an “ileocolectomy”) for many reasons. The most important is that it appears to have no function and though we create such valves in other circumstances, they are notoriously ineffective(they commonly leak in both directions and require multiple operations to fix) and in fact are done so as to DISALLOW the passage of food stuffs downstream(such as would be done in what is called a “continent ileostomy”). Most Crohn’s patients are having an ileocolectomy because of this problem already, in other words they have a stricture that disallows the passage of foodstuffs downstream and they have bowel obstruction symptoms. So recreating a ‘valve’ that once again compromises the passage of food stuffs is self-defeating. In fact there is some data that suggests certain medicines, like mesalamine work BETTER after an ileocolectomy with removal of the IC valve.

Thank you to Dr. Koltun for his time and expertise!